General discussion and future directions 247 psychiatric symptoms (1), overlap between social and psychiatric risk factors (2) and an indirect effect of ACE through psychiatric vulnerability (3). Discussions about family planning, desire for children and childlessness: should MHPs embark? The existing literature suggests that the prevention of UPs and/or involuntary childlessness begins with engaging in open conversations about desire for children and family planning53. However, surveys (Chapter 8,54-56), interviews57,58, and focus groups59 with MHPs (among which residents in psychiatry) reveals that the topic of family planning is not regularly broached in psychiatric healthcare. This contradicts the willingness of MHPs to discuss reproductive health matters (Chapter 8). This is probably due to insufficient knowledge on reproductive health matters (Chapter 8,54), the perception of this topic as a taboo (Chapter 4, 8,60), moral concerns (Chapter 8,57), limited time for appointments and lack of confidence55. By conducting a qualitative inquiry in the relation between family planning, desire for children and mental health, our thesis illustrates that family planning encompasses a spectrum of wishes, imaginaries and fears (Chapter 6, Chapter 7, Chapter 8). These aspects related to family planning provide insight in the many considerations that women with psychiatric vulnerability encounter and illustrates the need to have discussions in psychiatric healthcare. Aside from acknowledging the urge, qualitative inquiries also shed light on the topics to discuss (see Table 9.1). Table 9.1 - Top-5 topics to discuss in a conversation about family planning according to mental health professionals and patients from survey data. Topic Mental health professionals Patients 1 Effect of medication on pregnancy Is there a desire for children, and if so, why (not)? 2 Impact of pregnancy on mental health of parent (to be) Parenting in relation to psychiatric vulnerability 3 Is there a desire for children, and if so, why (not)? Impact of pregnancy and parenting on own mental health 4 Impact of heredity Impact of heredity 5 Contraceptive usage (Grieving) not having children Adopted from Chapter 8 According to MHPs and patients, family planning counseling included the consequences of pregnancy for patients themselves (e.g. mental health effect of pregnancy, childbirth and the postpartum period), as well as consequences for their offspring (e.g. parenting with psychiatric vulnerability, passing of genetic disorders) (Chapter 8). The ‘jar’ model is an exemplary model in which the impact of hereditary disorders is combined with environmental aspects such as vulnerability or resilience,
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